Dr. Goldstein explains if women can prevent vulvodynia and why taking hormonal birth control pills and family history increase the risk for this condition.
Can vulvodynia be prevented is the question, and the answer is, we probably don’t know. I see a lot of vulvodynia in women on oral contraceptive pills, young women who are on the pill, you know, I don’t know, age 15 and 16 and we see them in their early 20s or, you know, they have just finished college; they are now starting relationships and they have such pain in their vestibule.
We believe that birth control pills are associated with this vestibulodynia or vulvodynia. Early birth control pill users in the 15-year age group have 900 times more likely chance of having this condition than non-birth control pill users.
So there is that relationship and we believe that there are glands, geolandeous that release pre-cum, like in a guy who has pre-cum during sexual arousal, those same glands are in the vestibule. If you remember the vestibule is from the urinary system and those pre-cum glands are in the urinary system so women have those same glands.
Those are testosterone-dependent glands and women on birth control pills really lower their testosterone by virtue of stopping the ovary from working and by virtue of raising a protein in the blood called sex hormone binding globulin which then acts to bind whatever testosterone is available, leaving less free available, biologically available testosterone.
So, we strongly suggest that women who have sexual pain on birth control pills consider a different form of contraception, a non-hormonal version, mostly mechanically based like a progesterone IUD called the Mirena and we see the vestibule damage just melt away in about 50% of them, which is really cool.
So family history is definitely involved in this condition because vestibulodynia arguably is an abnormal response to inflammation, irritation, trauma and there are proteins that are involved in the healing of tissue and we can identify different genetic variations in these women who have vestibulodynia that where exposure to a certain form of injury results in excessive protein release that makes these nerves versus the normal population where a small amount of injury doesn’t release the similar amount of protein.
About Dr. Irwin Goldstein, M.D.:
Dr. Irwin Goldstein is Director of San Diego Sexual Medicine at Alvarado Hospital, the Secretary of the International Society for the Study of Women’s Sexual Health, a former President of the Sexual Medicine Society of North America and a Clinical Professor of Surgery at University of California at San Diego.
Dr. Goldstein has been involved with sexual dysfunction research since the late 1970s. His specialties include penile microvascular bypass surgery, surgery for dyspareunia, physiologic investigation of sexual function in men and women, and diagnosis and treatment of sexual dysfunction in men and women.